Outcome of Coronary Artery Bypass Graft with On-pump Beating-heart Technique


1 Department of anesthesiology, Faculty of medicine, Mashhad University of medical sciences, Mashhad, Iran

2 Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran

3 Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran


Background: This paper intends to evaluate the effects of on-pump beating-heart coronary artery bypass graft (CABG) in patients with coronary artery disease. Studies have shown that this surgical procedure can have acceptable results. Objectives: This study intends to share experiences and results of on-pump beating-heart CABG. Methods: We reported preliminary results related to mortality and morbidity in patients who underwent CABG in the period from 2015 to 2017 in Ghaem hospital, Mashhad, Iran. Results: 80 patients, in the period from 2015to 2017, underwent general anesthesia and on-pump beating-heart CABG surgery was done for them. The average number of grafts was 3.18± 0.474 and two patients died, unfortunately: one during surgery and one in ICU. There were no postoperative myocardial infarctions during the study. None of the patients reported kidney dysfunction. The average length of hospitalization was 4±1.11 days and the mean follow-up of the patients was 6 months. The average ejection fraction (EF) of patients was 43. 28± 9.58. Conclusion: In the last decade there has been a big challenge between using off-pump CABG and on-pump CABG, on-pump beating method could present acceptable and effective results.


1. Diegeler A, Börgermann J, Kappert U, Breuer M, Böning A, Ursulescu A, et al. Off-pump versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med. 2013; 368(13):1189-98. doi: 10.1056/NEJMoa1211666. [PubMed:
2. Nathoe HM, van Dijk D, Jansen EW, Suyker WJ, Diephuis JC, van Boven WJ, et al. A comparison of on-pump and off pump coronary Bypass surgery in low-risk patients. N Engl J Med. 2003;348(5):394-402. doi: 10.1056/NEJMoa021775.
[PubMed: 12556542].
3. Widimsky P, Straka Z, Stros P, Jirasek K, Dvorak J, Votava J, et al. One-year coronary bypass graft patency: a randomized
comparison between off-pump and on-pump surgery: angiographic results of the PRAGUE-4 trial. Circulation.
2004;110(22):3418-23. doi: 10.1161/01.CIR.0000148139. 79580.36. [PubMed: 15557371].
4. Puskas JD, Williams WH, Mahoney EM, Huber PR, Block PC, Duke PG, et al. Off-pump vs. conventional coronary artery
bypass grafting: early and 1-year graft patency, cost, and quality-of life outcomes: a randomized trial. JAMA.
2004;291(15):1841-9. doi: 10.1001/jama.291.15.1841.
5. Shroyer AL, Grover FL, Hattler B, Collins JF, McDonald GO, Kozora E, et al. On-pump versus off-pump coronary-artery
bypass surgery. N Engl J Med. 2009;361(19):1827-37. doi: 10.1056/NEJMoa0902905. [PubMed: 19890125].
6. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, et al. Off-pump or on-pump coronary artery bypass grafting at 30 days. N Engl J Med. 2012;366(16):1489-97. doi:10.1056/NEJMoa1200388. [PubMed: 22449296].
7. Mukherjee D, Ashrafian H, Kourliouros A, Ahmed K, Darzi A, Athanasiou T. Intra-operative conversion is a cause of masked mortality in off-pump coronary artery bypass: a meta-analysis. Eur J Cardiothorac Surg. 2012;41(2):291-9. doi:10.1016/j.ejcts.2011.05.023. [PubMed: 21684171].
8. Masuda M, Kuwano H, Okumura M, Amano J, Arai H, Endo S, et al. Thoracic and cardiovascular surgery in Japan during
2012. Gen Thorac Cardiovasc Surg. 2014;62(12):734-64. doi:10.1007/s11748-016-0622-7.
9. Keeling WB, Williams ML, Slaughter MS, Zhao Y, Puskas JD. Offpump and on-pump coronary revascularization in patients with low ejection fraction: a report from the Society of thoracic surgeons national database. Ann Thorac Surg. 2013;96(1):83-9. doi: 10.1016/j.athoracsur.2013.03.098. [PubMed: 23743061].
10. Kolh P, Windecker S, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC/EACTS guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European
Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous
Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg. 2014;46(4):517-92 .doi: 10.1093/ejcts/ezu366. [PubMed:
11. Edgerton JR, Herbert MA, Jones KK, Prince SL, Acuff T, Carter D, et al. On-pump beating heart surgery offers an alternative for unstable patients undergoing coronary artery bypass grafting. Heart Surg Forum. 2004;7(1):8-15. [PubMed: 4980839].
12. Mizutani S, Matsuura A, Miyahara K, Eda T, Kawamura A, Yoshioka T, et al. On-pump beating-heart coronary artery
bypass: a propensity matched analysis. Ann Thorac Surg. 2007;83(4):1368-73. doi: 10.1016/j.athoracsur.2006.11.011.
[PubMed: 17383341].
13. Polomsky M, He X, O’Brien SM, Puskas JD. Outcomes of offpump versus on-pump coronary artery bypass grafting: impact of preoperative risk. J Thorac Cardiovasc Surg. 2013;
145(5):1193-8. doi: 10.1016/j.jtcvs.2013.02.002. [PubMed: 23597624].
14. Chawla LS, Zhao Y, Lough FC, Schroeder E, Seneff MG, Brennan JM. Off-pump versus on-pump coronary artery bypass grafting outcomes stratified by preoperative renal function. J Am Soc
Nephrol. 2012;23(8):1389-97. doi: 10.1681/ASN.2012020122. [PubMed: 22595302].
15. Erkut B, Dag O, Kaygin MA, Senocak M, Limandal HK, Arslan U, et al. On-pump beating-heart versus conventional coronary artery bypass grafting for revascularization in patients with
severe left ventricular dysfunction: early outcomes. Can J Surg. 2013;56(6):398-404. doi: 10.1503/cjs.018412. [PubMed:
16. Rastan AJ, Bittner HB, Gummert JF, Walther T, Schewick CV, Girdauskas E, et al. On-pump beating heart versus off-pump coronary artery bypass surgery evidence of pump-induced myocardial injury. Eur J Cardiothorac Surg. 2005;27(6):1057-64. doi: 10.1016/j.ejcts.2005.03.007. [PubMed: 15896617].
17. Izumi Y, Magishi K, Ishikawa N, Kimura F. On-pump beatingheart coronary artery bypass grafting for acute myocardial infarction. Ann Thorac Surg. 2006;81(2):573-6. doi:10.1016/j. athoracsur.2005.08.036. [PubMed: 16427854].
18. Munos E, Calderon J, Pillois X, Lafitte S, Ouattara A, Labrousse L, et al. Beating-heart coronary artery bypass surgery with the help of mini extracorporeal circulation for very highrisk patients. Perfusion. 2011;26(2):123-31. doi: 10.1177/
0267659110395650. [PubMed: 21242193].
19. Narayan P, Rogers CA, Bayliss KM, Rahaman NC, Panayiotou N, Angelini GD, et al. On-pump coronary surgery with and without cardiologic arrest: comparison of inflammation, myocardial,
cerebral and renal injury and early and late health outcome in a single-center randomized controlled trial. Eur J Card Thorac Surg. 2011;39(5):675-83. doi: 10.1016/j.ejcts.2010.08.032.
20. Lin CC, Wu MY, Tsai FC, Chu JJ, Chang YS, Haung YK, et al. Prediction of major complications after isolated coronary
artery bypass grafting: the CGMH experience. Chang Gung Med J. 2010;33(4):370-9. [PubMed: 20804666].